EmploymentApplication

Personal Information

First Name

Last Name

StreetAddress

City, State, Zip Code

Primary Phone

Phone Type

Alternate Phone

Alternate Phone Type

Email Address

Do you have reliable transportation to get to work?

Yes No Not sure

Employment Desired

Preferred Schedule

Preferred Location

What Date Can You Start? (mm/dd/yy)

Desired Wages (per hour)

Are you currently employed?

Yes No

Do you have a valid MS Driver's License?

Yes No

Experience and Equipment/Tools

Please list any automotive experience you have had:

Please tell us of any automotive-type tools you own

Education

High School Attended (Name)

Did You Graduate HS?

Yes No

College (Name, if attended)

Did you graduate college?

Yes No

Subjects Studied

Please describe any other schools, what you studied, whether you graduated:

Please describe any other courses, training or studies you have had:

EMPLOYMENT HISTORY

Most Recent Employer

Name

Address

Phone Number

Salary

Position

Reason for Leaving

Start Date

End Date

Still employed?

Yes No

OK to contact your current employer?

Yes No N/A

Second Most Recent Employer

Name

Address

Phone Number

Salary

Position

Reason for Leaving

Start Date

End Date

Third Most Recent Employer

Name

Address

Phone Number

Salary

Position

Reason for Leaving

Start Date

End Date

References (please provide 3)

Ref #1 Name

Ref #1 Phone Number

How do you know this person?

Years known

Ref #2 Name

Ref #2 Phone Number

How do you know this person?

Years Known

Ref #3 Name

Ref #3 Phone Number

How do you know this person?

Years Known

Please enter any additional information you would like us to consider as part of your employment application:

Authorization:

By typing my name below as an electronic signature I certify that I am the person that is stated on this application for employement and the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for immediate dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Your Name (electronic signature)

Today's Date (mm/dd/yyyy)